Provider Demographics
NPI:1821212754
Name:BEHAVIOR SUPPORT SERVICES
Entity type:Organization
Organization Name:BEHAVIOR SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTOWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LIUDMILA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARDENASDIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:BCABA
Authorized Official - Phone:305-345-4627
Mailing Address - Street 1:10200 SW 120TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-4806
Mailing Address - Country:US
Mailing Address - Phone:305-259-0501
Mailing Address - Fax:305-259-0501
Practice Address - Street 1:10200 SW 120TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-4806
Practice Address - Country:US
Practice Address - Phone:305-259-0501
Practice Address - Fax:305-259-0501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0051671251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health